Osteoid osteoma arising in the phalanx is rather uncommon, and although the clinical and radiographic findings can be characteristic, the diagnosis is not always clear. In this article, we describe the case of a 9-year-old female who presented with a painful toe that, after careful evaluation and excisional biopsy, was determined to be caused by subperiosteal osteoid osteoma. The lesion was treated successfully with excision of the nidus.